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Fraud and Enforcement

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Fraud and Enforcement detects, prevents, investigates and assists in the prosecution of consumer and provider fraud relating to the business of insurance. The office investigates allegations of agent misconduct.

Fraud:Fraud investigates allegations of insurance fraud and works with local, state, and federal law enforcement agencies and prosecutors toward the goal of criminally prosecuting those who commit insurance fraud. Insurance fraud includes, but is not limited to inflating claims, misrepresenting facts in order to obtain insurance coverage or lower premiums, a doctor padding a health insurance claim, individual submitting false claims, or claims being made after false burglary reports. Insurance companies are required to report suspected fraudulent insurance claims to Fraud.

Enforcement:Every person who sells insurance in Ohio must be licensed and must adhere to the standards of conduct set forth in Ohio law. When an insurance agent’s conduct falls below those standards, Enforcement will conduct an investigation. An agent who violates an insurance law may lose his/her license or be subject to a fine and/or other sanctions. If the agent’s conduct is criminal in nature, the case is also referred to local or federal prosecutors for potential criminal prosecution.